COMPLEX PCI 2025
Left Main and Multi-Vessel Disease: Don't Be Trapped by Old Data N
At the 10th COMPLEX PCI 2025 in Seoul, Seung-Jung Park, MD, PhD (Asan Medical Center, Korea), delivered a provocative keynote address titled "Guideline-Based Real-World Practice." He boldly challenged the global medical community to stop relying on outdated clinical guidelines and to embrace 'State-of-the-Art PCI'—a modern approach driven by physiology and intravascular imaging—as a superior alternative for Left Main and Multi-Vessel disease. The "Blind Spot" of Current Guidelines: A Legacy of Outdated Trials He began by critically analyzing the evidence base of current international guidelines. He pointed out that the "Class I" recommendations for CABG in patients with multivessel disease, diabetes, or reduced ejection fraction are largely derived from historical trials such as CASS, STICH, SYNTAX, and FREEDOM. "These landmark trials compared medical therapy or surgery against PCI techniques from a bygone era," he noted. "They utilized bare-metal stents or first-generation drug-eluting stents and, most critically, were performed without the guidance of physiology or intravascular imaging." He emphasized that comparing modern surgical outcomes against outdated PCI data creates a distorted view of clinical reality, potentially denying patients less invasive treatment options that are now viable. Era of 'State-of-the-Art PCI' The core of his argument centered on the concept of "State-of-the-Art PCI." He defined this not merely as the implantation of a stent, but as a comprehensive procedural standard that integrates: Physiological Assessment: Using Fractional Flow Reserve (FFR) to precisely identify ischemia-causing lesions and avoid unnecessary stenting. Intravascular Imaging: Utilizing IVUS (Intravascular Ultrasound) or OCT (Optical Coherence Tomography) to ensure optimal stent expansion and apposition. Modern Devices: The use of the latest generation Drug-Eluting Stents (DES). "When we apply these precision tools, the clinical outcomes of PCI improve dramatically," he stated. "We must ask ourselves: if we treat a diabetic multivessel disease patient with 'State-of-the-Art PCI' today, would the results still be inferior to CABG? The old data cannot answer this question." A Paradigm Shift for Left Main and Multivessel Disease Addressing Left Main (LM) coronary artery disease, he highlighted that it should no longer be considered a condition requiring unconditional surgery. "For lesions with low to intermediate anatomical complexity, PCI has already proven its competitiveness," he asserted. He urged the audience to adopt a "Heart Team" approach that respects real-world evidence, where modern PCI offers a safe and effective alternative for high-risk patients who are often poor candidates for surgery. He concluded his lecture by calling for new, large-scale randomized controlled trials (RCTs) that evaluate 'State-of-the-Art PCI' against CABG, ensuring that future guidelines are built on evidence that reflects the current technological landscape. "We must not be trapped by the dogmas of the past," he remarked, setting a progressive tone for the remainder of the conference. "It is time to rewrite the rules based on the precision medicine we practice today." Opening & Workshop 1: Left Main & Multi-Vessel Disease Thursday, November 27, 10:30 AM ~ 12:00 PM Main Arena Watch Session Video
December 19, 2025 69
